Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 68723 | GA |
Y | 207YS0123X | Facial Plastic Surgeon | ME96799 | FL |
NPI | 1245327246 |
---|---|
Provider Name | Wilson Dumornay |
First Address | Plantation, FL 33317-2857 |
Second Address | Plantation, FL 33317-2857 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 24/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
68723 | GEORGIA MEDICAL LICENSE (01) | GA |
BD9966942 | DEA LICENSE (01) | FL |
ME 96799 | FLORIDA MEDICAL LICENSE (01) | FL |